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GWOT hot wash, straight from the wire

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HOW THE PURPLE HEART CAN HELP HEAL VETERANS WITH PTSD |

August 26, 2013

Name: MAJ Ben TupperReturned from: AfghanistanHometown: Syracuse, NY

Criteria
for the Purple Heart medal seems straightforward: “any action against an
enemy of the United States” in which a service member is “wounded or
killed” merits the award. But in practice granting of the award is a
contentious issue among combat veterans and a charged field for both the
wounded and those who judge the wounds.

Pablo Martinez Monsivais, Pool/AP

In
Afghanistan, I knew soldiers who earned Purple Hearts for very minor
wounds sustained in combat. Bruises and small lacerations that required
no stitches were technically eligible, and soldiers who received them
were rightly issued the medal. But technical criteria aside, most
soldiers look down on awards given for minor injuries, arguing that
doing so cheapens the Purple Heart’s significance for those who were
killed or more gravely wounded.

Today,
even while the Department of Defense wages a full-scale campaign to
educate service members on the legitimacy of mental health injuries
caused by war, many veterans are still discouraged from seeking
treatment for post-traumatic stress disorder (PTSD) by a fear of being
stigmatized. Current DoD policy, though a step in the right direction,
has not been enough to change a culture, both in and outside the
military, that still views PTSD as somehow less real than physical
traumas.

Given
these DoD attempts to promote understanding within the ranks that PTSD
is a legitimate product of war, the question before us is this: should
PTSD meet the criteria for the Purple Heart?

When
I posed this question to a wide range of veterans from Vietnam to
Afghanistan they universally answered “NO,” PTSD does not merit the
Purple Heart. I myself shared their opinion, until I began to
investigate the issue more closely and found that the reasons cited for
denying Purple Hearts for PTSD were fundamentally flawed and
inconsistent with other military award practices.

The
first issue of contention with PTSD is whether it’s a real “wound”, but
the answer to this is obvious and well documented by the fact that more
combat veterans from Iraq and Afghanistan die from suicide related to
wartime service and mental health issues, than from enemy bullets and
bombs. That should offer grave and definitive proof that PTSD is very
real and that its consequences can be as deadly as an IED.

Another
false premise used to undermine awarding the Purple Heart for PTSD is
that the mental disorder causes no physical damage nor changes to the
structure of the body. But the regulation for the Purple Heart never
makes any distinction between internal wounds or external wounds. The
precedent for awarding the Purple Heart for an internal mental wound is
in the case of traumatic brain injuries (TBIs), which cause no visible
disfigurement but still qualify for the Purple Heart. Finally, it is
important to note that although PTSD isn’t detectable from the surface,
the disorder does have a physiological signature and can be detected in
brain scans that show changes to the brain’s structures and wiring, much
like with TBIs.

Then
there is the argument that there is no clear chain of evidence linking
an enemy action to the onset of PTSD. The disorder can take months or
years to fully manifest and may be caused by more than one incident,
including traumas other than wartime service. Again, this objection is
moot given that the same argument can be made about TBIs, which can also
be cumulative and triggered by multiple causes that may have occurred
prior to war. No distinction is made for a wound that is initially
precipitated by falling off a bike as a child and later aggravated
during an IED explosion that culminates in a TBI when issuing the Purple
Heart to affected service members.

Finally,
the most frequent and emotionally charged objection to awarding the
Purple Heart for PTSD is the fear that people will fake symptoms to earn
the award. Sadly, fakery can occur in any military award and that is
why the current award system requires multiple witness statements to
corroborate the award narrative. The same stringent review would be
required for service members being submitted for PTSD related Purple
Hearts: corroborating witness statements documenting combat exposure, as
well as statements from professional mental health clinicians.

The
case for reconsidering PTSD and the Purple Heart might be made best by
turning from argument to the story of one of my combat veteran friends
from Afghanistan. My buddy, I’ll call him Ralph, was by my side in
combat many times, and in the course of these violent and harrowing
events he had a series of wounds inflicted on him. The first occurred
when a pebble-sized fragment of shrapnel ricocheted off his machine gun
shield and hit him in the fleshy part of his earlobe. There was minor
bleeding but within days the wound had healed. In accordance with the
regulations he was correctly and rightly awarded the Purple Heart
because the wound was incurred during combat and clearly caused by enemy
action. Some hardliners may scoff at this, but had the shrapnel hit two
inches to the right it could have taken out his eye and lodged in his
brain.

Months
after receiving the Purple Heart for the wound to his ear, Ralph
suffered a far more grievous injury that put him in the hospital for
months, mostly in a coma, where he was expected to die from the head
injuries he had suffered. After being released from the hospital he was
deemed unemployable for life and granted 100% disability status by the
Veterans Administration. Ralph now walks with a cane, is riddled with
scars and dependent on a wide range of medications to survive and manage
his pain. Yet for this second wound, by any measure more severe than
the wound he suffered to his earlobe, there will never be any Purple
Heart, because this second wound was PTSD.

Upon
returning home from war, Ralph was haunted by the comrades he lost and
the enemies he killed. In an attempt to escape his pain and grief Ralph
turned to drinking and long periods of solitary confinement, barricaded
in a small room in his father’s house. Some days when he felt especially
hopeless he would get behind the wheel of his car and drive fast in an
effort to flee and find relief. On one such day, craving the adrenaline
rush of combat, and fueled by rage and alcohol, he drove his car right
into a telephone pole and suffered the injuries that caused his coma and
continue to limit his mobility and physical health today.

Ralph’s
experience, taken together with the large and growing body of clinical
literature on PTSD, ought to be enough to finally dispel any lingering
notions that PTSD is any less legitimate or serious than other
battlefield wounds. A serious consideration should be given to revising
the award criteria to make those with mental and psychological injuries
caused by direct combat exposure eligible for the Purple Heart.

Granting
the Purple Heart is just the first step in fully legitimizing and
addressing PTSD. We also need systemic reform of the VA and a better
system for providing the long term clinical treatment that its
casualties deserve. But awarding the medal in cases of PTSD will
accomplish one essential goal: giving the respect and acknowledgement to
those who are suffering from invisible wounds that we already bestow on
those with scars we can see. By doing this, we would acknowledge that
the anxiety, rage, depression and disrupted emotional and social lives
that veterans with PTSD experience are a result of war, and not some
personal defect. By honoring them like we honor those scarred by bullets
and IEDs we may be able to alleviate some of the shame and fear that
have led so many to suicide.

Comments

You are completely right. I have never understood why people with PTSD are not honored like those with physical wounds are. They have played an important role and sacrificed just as much. I believe you are also right when you say that awarding the Purple Heart to those that suffer from PTSD may decrease suicide rates by reminding them that America is supporting them. Support the Troops! All of them.
Madi

Yes you are correct. I believe that the purple heart should be awarded to those with PTSD. I have not met anyone with PTSD, but i know about it's deadly effects. SOldiers sacrifice so much that their mind body and lives every day out there and to return home from battle a little shaken is normal. PTSD is serious and needs to be recognized nationwide. Thank you for sharing.